Maximum Eligible Expenses

Extended Health Provision

 

Drug Benefit

Benefit item Maximum Eligible Expense PSHCP pays

Eligible drugs

Reasonable and customary charges

80%

Erectile dysfunction drugs

$500 every calendar year on a combined basis

80%

Smoking cessation aids

 $1,000 in a lifetime

80%

Catastrophic drug coverage

Eligible drug expenses in excess of $3,000 out-of-pocket drug expense incurred in a given calendar year payable at 100%

100%

 

Vision Care Benefit

Benefit item Maximum Eligible Expense PSHCP pays

Eyeglasses/contact lenses (purchase and repairs)

$275 every two calendar years commencing every odd year

No limit if required as a result of surgery or accident and purchased within six months of the event

80%

Eye examinations

One examination every two calendar years commencing every odd year

80%

Laser eye surgery

$1,000 per lifetime

Surgery must be performed on or after October 1, 2014 to be eligible

80%

 

Medical Practitioners Benefit

Practitioner Maximum Eligible Expense PSHCP pays

Physiotherapist

Up to $500 and over $1,000 in a calendar year

80%

Psychologist, or social worker (when no psychologist practices in that isolated post)

$2,000 in a calendar year

In 2014:

$1,000 for expenses incurred between January 1 and September 30

$1,000 for expenses incurred between October 1 and December 31

80%

Massage Therapist

$300 in a calendar year

80%

Osteopath

$300 in a calendar year

80%

Naturopath

$300 in a calendar year

80%

Podiatrist or chiropodist

$300 in a calendar year

80%

Chiropractor

$500 in a calendar year

80%

Speech language pathologist

$500 in a calendar year

80%

Electrologist (or electrology treatment performed by a physician)

$20 per visit

80%

Nurse (nursing services)

$15,000 in a calendar year

80%

 

Miscellaneous Expense Benefit

Benefit item Maximum Eligible Expense PSHCP pays
Orthopaedic shoes $150 in a calendar year 80%
Servicing fees, repairs and replacement parts for CPAP and BiPAP machines

$300 per calendar year

Does not include expenses for cleaning supplies or warranties

Purchases must be made on or after October 1, 2014, to be eligible.

80%

Hearing aids (purchase/repairs)

$1,000 less any eligible hearing aid expenses claimed during the previous 60 months

No limit if required as a result of surgery or accident and purchased within 6 months of the event

80%

Orthopaedic brassieres

$200 in a calendar year

80%
Wigs $1,000 in a 60-month period 80%
Insulin jet injector device $760 during a 36-month period 80%

 

Out-of-Province Benefit

Benefit item Maximum Eligible Expense PSHCP pays

Emergency benefit while travelling / Emergency travel assistance services

$500,000 per period of travel (not exceeding 40 consecutive days)

100%
Referral benefit

$25,000 per illness or injury

80%

 

Hospital Provision

Level of coverage Maximum Eligible Expense PSHCP pays
Level I  $60 per day 100%
Level II  $140 per day 100%
Level III  $220 per day 100%

 

Basic Health Care Provision

Maximum Eligible Expense PSHCP pays

Three times (3x) the amount otherwise payable under the current fee schedule of the Health Insurance Act 1972 of Ontario

100%